title: CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC).
  
  
  RESULTS
  We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001).
  
  
  CONCLUSIONS
  Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.
authors.affiliation: Bellvitge University Hospital, Barcelona, Spain. Electronic address: aariza@bellvitgehospital.cat.
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sánchez-Elvira
authors.forename: José C
authors.initials: JC
authors.lastname: Sánchez-Salado
authors.forename: Victoria
authors.initials: V
authors.lastname: Lorente-Tordera
authors.forename: Joel
authors.initials: J
authors.lastname: Salazar-Mendiguchía
authors.forename: Remedios
authors.initials: R
authors.lastname: Sánchez-Prieto
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera-Torres
authors.forename: José L
authors.initials: JL
authors.lastname: Ferreiro-Gutiérrez
authors.forename: Joan A
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier-Fillat
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001777:Blood Coagulation / Q000187:drug effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: ACS; Acute coronary syndromes; Bleeding; CBRS; CRUSADE) bleeding risk score; NSTEMI; Non-ST segment elevation myocardial infarction; PCI; Percutaneous coronary intervention; Prognosis; ST segment elevation myocardial infarction; STEMI